"Dax's Case" Autonomy and Paternalism

Publication ID Published Volume
785 April 21, 2008 4


This is one of the most graphic videos you will ever see. Many medical schools have used it in the past and it is a classic, but some have decided not to use it because they didn't feel their students were ready for it or would be able to deal with it. I have decided the best thing to do was to not introduce it until the third year, when students are better prepared. But it is still likely to be quite disturbing to many observers.
I show the first 38 minutes of the video, in order to do justice to the personal perspectives of all the people who were involved in the case. One of the most important assumptions of patient-centered ethics (and narrative ethics) is that one cannot do justice to a case without knowing all of the social, economic, religious, and psychological factors that may influence the process. In other words, a good decision depends on more than medical expertise. No brief paper case can come close to the teaching value this video has. For one thing, one sees Dax's medical condition very graphically, but for another you see the views of all the major players, interviewed and speaking for themselves: the patient's mother, his nurse, plastic surgeon, ER doctor, rehabilitation medicine Fellow, and the psychiatrist involved (who made the video). Highest possible effectiveness, thanks to the unique video document. I used to show it to first year medical students, who would report eight years later (after residency) that it was the only thing they remembered from their first year. I've used it for fifteen years but never published it. I think it's a prime example of how teaching medical ethics has been a cottage industry, with each school having to re-invent the wheel. Must access the video; it is for sale by the Filmmaker's Library in NYC.


Spike J. "Dax's case" autonomy and paternalism. MedEdPORTAL Publications. 2008;4:785. http://doi.org/10.15766/mep_2374-8265.785

Educational Objectives

  1. To be able to identify and answer what is decision-making capacity?
  2. To be able to identify and answer do patients have the right to refuse treatment? Even when it is clearly beneficial?
  3. To be able to identify and answer what is paternalism, and when (if ever) is it justified?
  4. To be able to identify and answer what is Patient Autonomy and has Autonomy gone too far?


  • Paternalism, Treatment Refusal, Dax's Case, Burns, Jehovah's Witnesses, Right to Refuse

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ISSN 2374-8265